The Association Between Cannabis Use and Subsequent Nicotine Electronic Cigarette Use Among US Adolescents

Abstract

PurposeThe current study assessed the association between cannabis use among youth never e-cigarette users and subsequent e-cigarette use. MethodsThe Population Assessment of Tobacco and Health Study is a nationally representative cohort study. Participants aged 12 years and older were selected using a 4-stage, stratified probability sample design from the US civilian, noninstitutionalized population. We included adolescents who participated in both wave 4.5 (2017–2018) and wave 5 (2018–2019) of Population Assessment of Tobacco and Health, and were never e-cigarette users at baseline (N = 9,925). Through multivariable logistic regressions, we examined the prospective association between cannabis use and subsequent e-cigarette use. ResultsE-cigarette use at wave five was significantly more common among youth cannabis users at wave 4.5. The adjusted relative risks between ever cannabis use and subsequent past 12-month, past 30-day, and frequent e-cigarette use (≥20 days per month) were 1.53 (95% CI, 1.26–1.81), 1.70 (95% CI, 1.25–2.15), and 2.10 (95% CI, 1.17–3.03), respectively. The adjusted relative risks between past 30-day cannabis use and subsequent past 12-month, past 30-day, and frequent e-cigarette use were 1.54 (95% CI, 1.04–2.28), 2.01 (95% CI, 1.23–3.29), and 2.87 (95% CI, 1.44–5.71), respectively. We also found significant associations between ever cannabis vaping with subsequent e-cigarette use. DiscussionWhile previous research associates e-cigarette use with subsequent onset of cannabis use, we identify a reverse directional effect, where adolescent cannabis use is associated with increased likelihood of future e-cigarette use.